Provider Demographics
NPI:1336214196
Name:HONEYCUTT, AMY C (LMP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:HONEYCUTT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16115 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8863
Mailing Address - Country:US
Mailing Address - Phone:253-318-8111
Mailing Address - Fax:253-531-1264
Practice Address - Street 1:103 103RD ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4807
Practice Address - Country:US
Practice Address - Phone:253-318-8111
Practice Address - Fax:253-531-1264
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist